System and method for closed-loop patient-adaptive hemodynamic management

• US 8,617,135 B2
• Filed: 01/12/2012
• Issued: 12/31/2013
• Est. Priority Date: 01/12/2011
• Status: Active Grant

• Current Assignee: Regents of the University of California (University of California)
• Original Assignee: Regents of the University of California (University of California)
• Inventors: Rinehart, Joseph B., Cannesson, Maxime
• Primary Examiner(s): VU, QUYNH-NHU HOANG
• Application Number:
  US13/349,114
• Publication Number:
  US 20120179135A1
• Time in Patent Office: 719 Days
• Field of Search: 604503-504, 604/66, 600300-301, 600508-509
• US Class Current: 604/503
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/0245 by using sensing means generating electric signals, i.e. ECG signals
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 5/0295 using plethysmography, i.e. measuring the variations in the volume of a body part as modified by the circulation of blood therethrough, e.g. impedance plethysmography
• CPC Class Codes: A61B 5/14542 for measuring blood gases A61B5/14551 takes precedence
• CPC Class Codes: A61B 5/4833 Assessment of subject's compliance to treatment
• CPC Class Codes: A61B 5/7203 for noise prevention, reduction or removal
• CPC Class Codes: A61M 2202/0208 Oxygen
• CPC Class Codes: A61M 2205/502 User interfaces, e.g. screens or keyboards
• CPC Class Codes: A61M 2205/52 with memories providing a history of measured variating parameters of apparatus or patient
• CPC Class Codes: A61M 2230/00 Measuring parameters of the user
• CPC Class Codes: A61M 2230/04 Heartbeat characteristics, e.g. ECG, blood pressure modulation
• CPC Class Codes: A61M 5/142 Pressure infusion, e.g. using pumps
• CPC Class Codes: A61M 5/16877 Adjusting flow; Devices for setting a flow rate
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: G16H 20/17 delivered via infusion or injection

Abstract

A system and method for patient-adaptive hemodynamic management is described. One embodiment includes a system for hemodynamic management including transfusion, volume resuscitation with intravenous fluids, and medications, utilizing monitored hemodynamic parameters including the described dynamic predictors of fluid responsiveness, and including an intelligent algorithm capable of adaptation of the function of the device to specific patients.

Claims

1. A computer-implemented method for facilitating the administration of an intravenous fluid to a patient in order to effect intravascular volume expansion, the method comprising:

determining a first effect on a physiologic parameter of the patient associated with administration of a first fluid bolus to the patient wherein the first fluid bolus comprises a first quantity of a first intravenous fluid administered for the purpose of intravascular volume expansion;

storing, using a processor, first information relating to the first effect in a first bolus log entry;

determining a second effect on the physiologic parameter of the patient associated with administration of a second fluid bolus to the patient wherein the second fluid bolus comprises a second quantity of a second intravenous fluid administered for the purpose of intravascular volume expansion;

storing, using a processor, second information relating to the second effect in a second bolus log entry; and

generating, using the processor, a fluid administration signal useable to control the administration of the intravenous fluid wherein the fluid administration signal is based at least in part upon at least one of the first bolus log entry and the second bolus log entry.

2. The method of claim 1 wherein the generating further includes determining a predicted change in the physiologic parameter based upon the first bolus log entry and a predicted response to administration of the first fluid bolus wherein the predicted response is associated with a population group.

3. The method of claim 1 further including receiving input information relating to one or more physiologic processes of the patient, the generating being further based upon the input information.

4. The method of claim 1 wherein the generating further includes determining a predicted change in the physiologic parameter of the patient in response to administration of a fluid bolus to the patient.

5. The method of claim 1 wherein the determining the first effect on the physiologic parameter includes receiving input information comprising measurements of one or more physiologic processes of the patient.

6. The method of claim 1 wherein the determining the first effect on the physiologic parameter includes receiving input information relating to variation in one or more physiologic processes of the patient.

7. The method of claim 1 wherein the determining the first effect on the physiologic parameter includes receiving input information relating to at least one of pulse pressure variation, stroke volume variation, plethysmograph waveform variability, and EKG waveform variability of the patient.

8. The method of claim 1 wherein the intravenous fluid, the first intravenous fluid, and the second intravenous fluid comprise the same fluid.

9. The method of claim 1 wherein the intravenous fluid comprises a crystalloid solution.

10. The method of claim 1 wherein the intravenous fluid comprises a colloidal solution.

11. The method of claim 1 wherein the fluid administration signal is also useable to control the administration of a medication.

12. The method of claim 1 wherein the generating is based at least in part upon an expected change in the physiologic parameter in a patient population in response to infusion of the first fluid bolus in patients included in the patient population.

13. The method of claim 12 further including receiving information relating to a medical condition of the patient and determining the patient population based at least upon the medical condition.

14. The method of claim 13 wherein the medical condition is included within state information associated with the patient, the method further including determining the patient population by selecting the patient population from among plural patient populations based at least upon the state information.

15. The method of claim 1 further including receiving input information comprising measurement values relating to one or more physiologic processes of the patient, the generating including determining a predicted change in the physiologic parameter based at least in part on the measurement values.

16. The method of claim 15 wherein the determining the predicted change is based at least in part upon information relating to an expected change in the physiologic parameter in a patient population in response to infusion of the first fluid bolus in patients included in the patient population.

17. The method of claim 15 further including filtering the measurement values.

18. The method of claim 17 wherein the filtering includes comparing ones of the measurement values to other of the measurement values.

19. The method of claim 15 further including identifying artifacts among the measurement values by determining, based upon the measurement values, relative changes in one or more physiologic parameters of the patient.

20. A device, comprising:

one or more processors; and

a memory operatively coupled to the one or more processors, the memory storing program code which, when executed by the one or more processors, determines a first effect on a physiologic parameter of the patient associated with administration of a first fluid bolus to the patient wherein the first fluid bolus comprises a first quantity of a first intravenous fluid administered for the purpose of intravascular volume expansion, stores first information relating to the first effect in a first bolus log entry within device storage, determines a second effect on the physiologic parameter of the patient associated with administration of a second fluid bolus to the patient wherein the second fluid bolus comprises a second quantity of a second intravenous fluid administered for the purpose of intravascular volume expansion, stores second information relating to the second effect in a second bolus log entry within the device storage, and generates a fluid administration signal useable to control the administration of an intravenous fluid wherein the fluid administration signal is based upon at least one of the first bolus log entry and the second bolus log entry.

21. The device of claim 20 wherein the intravenous fluid, the first intravenous fluid and the second intravenous fluid comprise a crystalloid solution.

22. The device of claim 20 wherein the intravenous fluid comprises a colloidal solution.

23. The device of claim 20 wherein the fluid administration signal is also useable to control the administration of a medication.

24. An infusion system, comprising:

a pump apparatus configured to control delivery of an intravenous fluid to a patient to effect intravascular volume expansion; and

a controller that determines a first effect on a physiologic parameter of the patient associated with administration of a first fluid bolus to the patient wherein the first fluid bolus comprises a first quantity of a first intravenous fluid administered for the purpose of intravascular volume expansion, stores first information relating to the first effect in a first bolus log entry within device storage, determines a second effect on the physiologic parameter of the patient associated with administration of a second fluid bolus to the patient wherein the second fluid bolus comprises a second quantity of a second intravenous fluid administered for the purpose of intravascular volume expansion, stores second information relating to the second effect in a second bolus log entry within the device storage, and provides a fluid administration signal to the pump apparatus based upon at least one of the first bolus log entry and the second bolus log entry wherein the fluid administration signal is useable to control the administration of the intravenous fluid.

25. The infusion system of claim 24 wherein the intravenous fluid comprises a crystalloid solution.

26. The infusion system of claim 24 wherein the intravenous fluid comprises a colloidal solution.

27. The infusion system of claim 24 wherein the fluid administration signal is also useable to control the administration of a medication.